960 / Senior Citizen Fall Risk Check including Recommendations for Mobility in Daily Living

GERMANY
Classification of the PSP
Type of Patient Safety Practice Safe
 
Clinical Risk Management Practice (CRMP)
Related practices from PaSQ database
"Best fit" category of the reported practice
Education in Patient Safety
Methods for literacy and patient involvement There is no specified text here
Topic of the reported practice
Patient empowerment
Aim and the benefit of the Patient Safety Practice
 
Mobility is one of the most important factors for well-being and autonomy in old age. Impairments in mobility, falls and fear of falling including avoidance behaviours are, therefore, of prognostic value.

Falls generally result from an interaction of multiple risk factors. However, older people are often not aware of the risks of falling. They neither recognize risk factors nor report these factors to their physicians.

The aim was to develop and to test a self-reported multidimensional screening instrument (a) to evaluate risk factors of falling in community-dwelling senior citizens and also (b) to focus on individual resources for primary preventive activities. Therefore, we identified multiple risk factors of falls based on a systematic literature review and then developed a new questionnaire – the Senior Citizen Fall Risk Check including Recommendations for Mobility in Daily Living.
Description of the Patient Safety Practice
 
Purpose: A strong relation between mobility, walking safety and living independently in old age exists. Community-dwelling senior citizens with walking problems are suffering from fear of falling and tend to restrict their mobility and performance level in the community environment– even before succeeding falls. The aim was to improve the public health oriented approach to identify community-dwelling senior citizens at (a) no risk, (b) moderate or (c) high risk of falling. Therefore, the Senior Citizen Fall Risk Check including target group specific recommendations for mobility in daily living was developed.

Method: Domains of the development process of the Senior Citizen Fall Risk Check: (a) multiple risk factors of falls based on a systematic literature review were identified; (b) a new self-filling questionnaire (screening) was developed; (c) target group specific written recommendations for mobility were included; (d) pre-tests were carried out; (e) feasibility, acceptance and reliability, were tested and finally (f) analyses of the validity and prognostic value of the Senior Citizen Fall Risk Check targeting independently living senior citizens were carried out before (g) implementation and (h) dissemination on regional and national level.

Implementation: Together with the Ministry for Health and Consumer Protection, City of Hamburg, the Senior Citizen Fall Risk Check including target group specific recommendations for mobility in daily living was first published in 2008. Furthermore, a CD-ROM toolkit containing screening for falls, recommendations for mobility in daily living, checklists and examples of good practice, training programmes for professionals and care givers was developed by the research department, Albertinen-Haus and is available at Ministry for Health and Consumer Protection.

The activity is integrated in the overarching regional stakeholder platform “Pakt für Prävention” (PfP) established by the Ministry of Health in 2010. Up to date 105 institutions signed the commitment (www.hamburg.de/pakt-fuer-praevention). An Executive Board led by the BGV and the Hamburg Association for Health Promotion (HAG) facilitates their engagement. Activities focus on identification of good practice, dissemination and sustainable implementation, and on identifying gaps and deficits. Healthy ageing focuses on the benefits of lifelong health promotion and mobility for independent living. Using the knowledge of the stakeholder platform as well as the rationale of research data and health reporting, a socio-spatial approach is chosen for an awareness campaign for prevention of falls. There are strong participatory elements in the development of the initiative involving practically all relevant actors. There is also a strong cooperation based on written consensus between academia, clinicians, research, health authorities, policy makers and long term care providers.

Evaluation: Took place in different preventive programmes embedded in the working group “Fall prevention and mobility in old age” coordinated by the Health Department of the City of Hamburg as well as in defined subsamples (robust and prefrail participants 60 years and older) from the Hamburg Longitudinal Urban Cohort Ageing Study (LUCAS).

Dissemination on regional and national level:
Senior Citizen Fall Risk Check including recommendations for mobility in daily living
Manual “Sicher gehen – weiter sehen. Selbsttest zur Sturzgefahr im Alter mit Bausteinen für mehr Gangsicherheit und Mobilität“.
6. Aktualisierte Auflage, Hamburg 2013. Download:
http://www.hamburg.de/contentblob/895024/data/sicher-gehen-broschuere-2008.pdf

Fall Risk Check to identify Fear of Falling in Old Age
Screening „Sturztest zur Sturzgefahr im Alter“. Kuratorium Knochengesundheit e.V., Sinsheim 2012. Download:
http://www.osteoporose.org
Attachment of relevant written information and/or photos, as appropriate
201403101257462483_WP4_Manual Sicher gehen und Empfehlungen.pdf
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Effectiveness of the Patient Safety Practice
 
Degree of implementation of reported practice
Yes, fully
Level of implementation of reported practice
Regional or national level
Specific and measurable outcome for the reported practice were defined
Yes
A baseline measurement before implementation of the reported practice was obtained
Yes
A measurement after full implementation of the reported practice was obtained
Yes
Evaluation of a "positive" effect of the reported practice on Patient Safety
The evaluation showed improvements in Patient Safety outcomes
Type of before-and after evaluation
Both/mixed (qualitative and quantitative)
Enclosure of a reference or attachment in case of published evaluation's results
Baseline:
Anders J, Dapp U, Laub S, von Renteln-Kruse W, Juhl K. Screening of fall risk in frail, but still independently living senior citizens. Z Gerontol Geriatr 2006; 39:268-276 [German]. doi 10.1007/s00391-006-0395-1

Fall prevention in the community:
Anders J, Dapp U, Laub S, von Renteln-Kruse W. Impact of fall risk and fear of falling on mobility of independently living senior citizens transitioning to frailty: screening results concerning fall prevention in the community. Z Gerontol Geriatr 2007; 40:225-267 [German]. doi 10.10007/s00391-007-0469-8

Incorporated in the LUCAS consortium in Hamburg:
Renteln-Kruse von W, Dapp U, Anders J, Pröfener F, Schmidt S, Deneke C, Fertmann R, Hasford J, Minder C. The LUCAS* consortium: objectives of interdisciplinary research on selected aspects of ageing and health care for older people in an urban community. Z Gerontol Geriatr 2011; 44:250-5. doi: 10.1007/s00391-011-0224-z

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Health care context where the Patient Safety Practices was implemented
 
Primary care
Community care facility
Community pharmacy
Transferability
 
Successful implementation of this Patient Safety Practice in other health care settings than above stated
No
Specification of implementation in another health care setting(s)
There is no specified text here
Successful implementation's level  of this Patient Safety Practice across settings
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Involved health care staff
 
Physicians
Nurses
Pharmacists
Therapists
Social workers
Dieticians/ Nutritionists
Scientific staff / researchers
Quality manager
Patient Involvement
 
Direct service user's involvement as integral part of this Patient Safety Practice
Yes
Specification of the service users or their representatives' involvement in the implementation of this Patient Safety Practice
Patient(s)
Relative(s)
Patient representative(s)
Patient organisation(s)
Other
Point of time in which service user or their reprasentatives' involvement takes place
During the development of the Patient Safety Practices
During the implementation of the Patient Safety Practices
During the application of the Patient Safety Practice
During the evaluation of the Patient Safety Practices
Active seeking of service users' opinion, feedback, experience, etc. as integral part of this Patient Safety Practice
Yes
Short description of the service users' level of involvement
Collaboration, such as co-designing a Patient Safety Practice or active partnership in implementation
Public accessibility of information regarding this Patient Safety Practice to patients and citizens/service users
Yes
List of sources where public information is accessible
On national level:
http://www.osteoporose.org

On regional level:
City of Hamburg: Public Health Information Service: http://www.hamburg.de/gesundheit-im-alter/843998/sturzpraevention-im-alter-broschuere.html

Web-Site: Research Department Albertinen-Haus Hamburg
Mobility in old age
http://www.albertinen.de/krankenhaeuser/geriatrische_klinik/leistungsspektrum/geriatrische_forschung/aktuelle_forschungsprojekte/mobilitaet
LUCAS Consortium
http://www.albertinen.de/krankenhaeuser/geriatrische_klinik/leistungsspektrum/lucas
Implementation of the Patient Safety Practice
 
Existing collaboration with other countries or international organisations related to implementation of this Patient Safety Practice
Yes
Problems encountering in the implememntation course of this Patient Safety Practice like lack of motivation, no management support, etc.
No
List of the most prevelent difficulties encuntered during implementation of this Patient Safety Practice
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List of the most prevalent drivers for a successful implemetation of this Patient Safety Practice
Equipment was enhanced or new
Use of any specific incentives to enhance motivation while implementing this Patient Safety Practice
No
Description of used incentives, if any.
There is no specified text here
Existence of support or approval by the clinical or hospital management or any other hihg level authority in the implementation process of this Patient Safety Practice
Yes
Costs of the Patient Safety Practices
 
Completion of cost calculation related to this Patient Safety Practice
No
Total number of person days required to implement this Patient Safety Practice
Clinical staff: There is no specified text here
External consultants: There is no specified text here
Support staff: There is no specified text here
Managerial staff: There is no specified text here
Others: There is no specified text here
Not relevant: There is no specified text here
Total number of person days required for training as preparation for implementation of this Patient Safety Practice
Clinical staff: There is no specified text here
External consultants: There is no specified text here
Support staff: There is no specified text here
Managerial staff: There is no specified text here
Others: There is no specified text here
Not relevant: There is no specified text here
Total cost in Euro of specific equipment (machines, software, communications supplies, etc.) needed to support implementation of this Patient Safety Practice
There is no specified text here
Associated cost with a work reduction or foregoing in order to deliver this Patient Safety Practice
There is no specified text here
Contact information
 
Name: Dr. rer. nat. Ulrike Dapp
Country: GERMANY
Organisation: Albertinen-Haus, Geriatrics Centre, University of Hamburg
E-mail: ulrike.dapp@albertinen.de
Phone: There is no specified text here
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